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SCIPS
St. Cecelia's Inter-Parish Singles
A not for profit SINGLES Activity Club for Fun and Friendship
APPLICATION FOR MEMBERSHIP
Name _______________________________________ Birth Month/Day_____________
Address ___________________________________________________
City ____________________ State _____ ZIP ___________ Telephone ____________
Email Address _________________________________
Circle: Divorced, Widowed, Separated, Never married
Sponsor Member_____________________________________________________
Skills/interests_______________________________________________________
Committees I would like to serve on: CHECK one or more:
Set-up Dance, Greeter, Set-up Picnic
Publicity, Membership, Door Prizes
Hospitality, Newsletter, Refreshments
Decorations, Ice and Soda, Clean up
Suggestions for Programs _________________________________________
Suggestions for Activities: ___________________________________________
I am interested in becoming a member of SCIPS and I will abide by the rules and regulations of
the club.
Date _______________ Signature ______________________________
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